Efficiency of Corticosteroid Treatment in Resolution of Bilateral Abducens Paralysis After Head Trauma
3
Citation
11
Reference
10
Related Paper
Citation Trend
Abstract:
A rare case of posttraumatic bilateral abducens palsy is presented. A 17-year-old male patient referred to our clinic because of complaints of diplopia, difficulty in opening his mouth, pain in the face, dyspnea, and chest pain after head trauma from a motor vehicle accident. The patient was not able to abduct eyes bilaterally, and diplopia occurred in the lateral gaze. All other extraocular movement was intact. He also had a mandibular fracture and bilateral pneumothorax. Computed tomography scan of the cranium showed no intracranial or extracranial hemorrhage, no mass effect, and no edema. No abnormalities were seen in the orbits, sinuses, skull base, and calvarium. For the treatment of sixth cranial nerve palsy, we applied corticosteroid therapy and waited for spontaneous recovery. During follow-up, at 3 months after discharge, he showed marked improvement in his ocular mobility and alignment without any residual limitation of abduction bilaterally. A bilateral sixth nerve palsy is rarely seen after a head trauma without cranial pathologic findings, and corticosteroid therapy may have beneficial effects during treatment besides spontaneous resolution.Keywords:
Abducens nerve
Head trauma
Orbit (dynamics)
The purpose of this study was to demonstrate two cases of vertical diplopia after cataract surgery and to discuss the mechanism and types of strabismus caused by the local anesthesia with retrobulbar injection. Two cases of vertical diplopia after cataract surgeries were reported. They were operated by the same surgeon and both happened to the left eye and both presented with marked left hypotropia. The clinical findings consisted of overacting left inferior rectus (LIR) in case 1 and mixed overacting and restrictive LIR in case 2. The diplopia and left hypotropia were eliminated after muscle operation. Retrobulbar injection is a basic technique in ophthalmic practice. Although it is generally safe, complications do happen in certain cases including diplopia and strabismus. Ophthalmologists should know about the orbital anatomy and learn to prevent any accidental insult to extraocular muscles.
Strabismus Surgery
Cite
Citations (1)
BACKGROUND: Diplopia identifies patients with eye muscle involvement in Graves' ophthalmopathy (GO). OBJECTIVE: To identify clinical parameters that could eliminate the need for magnetic resonance imaging (MRI) to assess the activity of inflammation in the eye muscles of GO patients with diplopia. METHODS: In 43 patients with GO with recently developed diplopia, orbital ultrasound and MRI were performed. Muscle diameters and MRI T2 relaxation times were measured, and the amount of orbital connective tissue was calculated from MRI scans and compared with ultrasound readings, diplopia grades, degree of protrusion, ocular pressure, tear production, antibody levels and hormonal parameters of thyroid function. RESULTS: No correlation was found between diameters of 233 extraocular muscles measured by MRI and by ultrasound. For each of the four muscles, there was a diameter above which ultrasound was always unreliable. MRI data were used in further analysis. Of the muscles examined, the inferior rectuses were the most frequently enlarged - at least one, in 93% of cases. Medial, lateral and superior rectuses were enlarged in 59%, 37% and 34% of the orbits respectively. The pattern of muscle involvement of the two orbits tended to be symmetric (r=0.49, P=0.003), particularly for the medial rectuses (r=0.90, P=0.000). Proptosis correlated with the sum of the muscle diameters for a given eye (right eye: r=0.54, P=0.003; left eye: r=0.57, P=0.001), but it failed to correlate with the amount of orbital connective tissue. In 53% of the patients, normal T2 relaxation times were found in all eight muscles. There was only a weak correlation between muscle thickness and T2 relaxation time (r=0.49, P=0.003), indicating that muscle enlargement alone is not a sign of disease activity. The severity of diplopia was independent of T2 relaxation time. The amount of orbital connective tissue showed a negative correlation with the greatest T2 relaxation time for a given eye (r= -0.52, P=0.004); this suggests that disease types exist that have predominant muscle involvement and predominant connective tissue expansion. No correlation between connective tissue expansion and proptosis, diplopia grade, muscle thickness or disease duration was found - that is, connective tissue expansion is not a major factor in diplopia. Both muscle and connective tissue findings were independent of thyroid function. CONCLUSION: Ultrasound and MRI eye muscle diameter readings do not correlate, because of the inherent inaccuracy of orbital ultrasound. Muscle enlargement alone does not mean oedematous swelling and active disease. Neither ultrasound, nor any combination of 11 clinical and laboratory parameters provided the degree of information on muscles and connective tissue that was obtainable by MRI. In unclear cases of recently developed diplopia, before orbital decompression surgery, in the case of treatment failure or if, for any other reason, imaging is needed in GO, MRI is the method of choice.
Graves' ophthalmopathy
Medial rectus muscle
Exophthalmos
Eye muscle
Cite
Citations (93)
Graves' ophthalmopathy
Surgical decompression
Cite
Citations (0)
Surgical decompression
Graves' ophthalmopathy
Cite
Citations (13)
Epidural Blood Patch
Abducens nerve
Sixth nerve palsy
Trochlear nerve
Cite
Citations (42)
Abducens nerve
Cite
Citations (3)
Traumatic bilateral abducens nerve palsy is rare. Bilateral palsy due to a force applied at an angle is even more unusual. We report a case of bilateral traumatic abducens nerve palsy without fracture after striking the right side of the face in a fall. The palsy did not improve after several months and the patient underwent successful corrective surgery. The literature on bilateral traumatic abducens nerve palsy is reviewed. Possible mechanisms are discussed, as well as a possible mechanism for traumatic bilateral abducens nerve palsy with force applied at an angle.
Abducens nerve
Trochlear nerve
Cite
Citations (3)
Grave's ophthalmopathy is an inflammatory, autoimmune disorder often associated with Grave's disease. The inflammatory infiltration involves the retrobulbar fatty tissue and the extrinsic eye muscles, causing proptosis, extraocular muscle dysfunction and often diplopia. Orbital decompression is an effective treatment in such cases, particularly when resistant to drugs and external radiation therapy. This work compares the results of orbital decompression performed by removing: a) the medial and lateral walls (Mourits technique) in 10 patients (19 orbits) and b) the medial and lower walls (Walsh-Ogura technique) in 17 patients (31 orbits). The results show that removing the floor of the orbit enables better reduction of proptosis but more easily leads to post-operative diplopia. Thus it proves necessary to combine the two techniques, modifying the surgical approach on a case-by-case basis.
Orbit (dynamics)
Graves' ophthalmopathy
Orbital Diseases
Cite
Citations (3)
Leptomeninges
Cite
Citations (12)
Cranial nerves palsy associated with preeclampsia is reported in literature. Facial and abducens palsies were the most nerve disorders described. Only eleven cases have been reported in the literature. We report the case of a 27-years-old patient who presented abducens nerve palsy in immediately after the delivery of severe pre-eclampsia. No specific pathology was found. Symptoms of abducens nerve palsy have resolved spontaneously by controlling blood pressure after delivery.
Abducens nerve
Cite
Citations (0)